[Congressional Record Volume 144, Number 146 (Wednesday, October 14, 1998)]
[Extensions of Remarks]
[Page E2161]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




            INTRODUCTION OF THE QMB IMPROVEMENT ACT OF 1998

                                 ______
                                 

                           HON. JIM McDERMOTT

                             of washington

                    in the house of representatives

                      Wednesday, October 14, 1998

  Mr. McDERMOTT. Mr. Speaker, today Mr. Stark and I introduced 
legislation that will dramatically improve the Medicare program for its 
low-income beneficiaries. If passed, our legislation will ensure that 
Medicare beneficiaries eligible for existing income protections 
actually receive the benefits they deserve.
  The current Medicare program places many beneficiaries at risk due to 
the inadequacy of its benefit package. Specifically, Medicare's high 
out-of-pocket costs for ``covered services'' and its failure to cover 
the cost of prescription drugs and long-term care can seriously erode a 
beneficiary's total family income. Additionally, as Congress continues 
to push all beneficiaries into Medicare managed care, many more low- 
and moderate-income beneficiaries will face increased financial risks.
  In 1995, 12.2% of Medicare's 35 million beneficiaries were at or 
below 100% of the Federal Poverty Level (FPL), 6.2% were between 100% 
and 120% FPL, and 4.9% had incomes between 120% and 135% FPL. Despite 
their dual eligibility for both Medicare and Medicaid, health care 
spending averaged roughly 30% of their total family income.
  The programs that Congress designed to protect low-income 
beneficiaries from unreasonable out-of-pocket costs--the Qualified 
Medicare Beneficiary (QMB), Specified Low-Income Beneficiary (SLMB), 
and Qualified Individuals (QI-1 and QI-2) programs--are notorious for 
having poor enrollment of eligible Medicare beneficiaries.
  A recent report by Families USA found that nationwide, roughly 3.5 
million Medicare beneficiaries are eligible for QMB, SLMB & QI-1 
benefits but are not receiving them. The report highlighted that 
Washington State was the 10th worst state at enrollment with roughly 
100,000 eligible beneficiaries not covered--costing WA low-income 
beneficiaries $55 million alone in lost Social Security benefits.
  The lost Social Security benefits are attributable to eligible 
seniors having their part B premiums automatically deducted by Medicare 
from their Social Security checks each month even though they are 
eligible for one of the existing income protection programs. The loss 
of $43.80 month/$525.60 year is tremendous to a Medicare beneficiary 
whose income hovers around $8,000 to $9,000 a year.
  The reasons for poor enrollment vary, so rather than dwell on our 
collective failure, we propose action to fix the problem. Our 
legislative solution simply would presumptively enroll eligible 
Medicare beneficiaries in the appropriate QMB or SLMB protection 
program--enrolling as close to 100 percent of eligibles as possible.
  As Congress and the National Commission on the Future of Medicare 
struggle to reform the Medicare program, we need to keep an open mind 
about how we can do more to improve, rather than harm, the program.
  Presumptively enrolling current Medicare eligibles for existing low-
income protections would be a good start. My hope is that in addition 
to making this necessary improvement, the next Congress and the 
Commission also will consider other options to enhance the low-income 
protections such as simplification through federalization and 
modernizing its eligibility, income, and asset test criteria.

       Medicaid Protections for Low-income Medicare Beneficiaries

       QMB: Qualified Medicare Beneficiaries eligible for 
     financial assistance covering Medicare premiums, deductibles, 
     and copayments for singles/couples at or below 100% of 
     poverty--$8,292/$11,100 year.
       SLMB: Specified Low-Income Medicare Beneficiaries eligible 
     for Part B premium assistance for singles/couples between 100 
     & 120% of poverty--$9,900/$13,260 year.
       QI-1: BBA '97 allows Qualified Individuals to apply for 
     block grant assistance to pay for Part B premiums if the 
     single/couple's income is between 120 and 135% of poverty--
     $11,112/$14,892 year.
       QI-2: BBA '97 allows Qualified Individuals to apply for 
     assistance to pay for the portion of the Part B premium 
     increase caused by transfer of Home Health Services from Part 
     A to Part B if the single/couple's income is between 135 and 
     175% of poverty. This benefit is estimated to be worth $1.07/
     month per beneficiary.
       Part B premiums cost $43.80/month equaling $525.60/year.

       

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